This week in the Legislature, SB 1884 was amended in Senate Appropriations to phase in the transition to enrollment-based county Medicaid cost-sharing over seven years. Originally, the bill called for an immediate transition, which would have caused many counties to experience substantial growth in their Medicaid bills between the current year and FY 2013-14. The bill has been placed on the Special Order calendar for Monday, April 26, and FAC staff continues to work with Sen. Grimsley and Senate staff on language that will address the counties’ concerns. FAC has updated its summary and fiscal analyses of the bill, which can be found here.
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County Medicaid Contributions
SB 1884 (Health Policy); formerly SPB 7156
- Summary: SB 1884 replaces the existing county-state Medicaid cost-sharing relationship, which requires the counties to reimburse the state for a share of certain inpatient hospital days and nursing home costs, with a fixed, formula-based county contribution. As amended in Senate Appropriations, SB 1884:
- Sets a total FY 2013-14 county contribution base amount of $269.6M, which is the REC’s estimate for medical hospital fee revenues (i.e. county Medicaid contributions in s. 409.915, F.S.).
- Provides that the FY 2013-14 base amount would be adjusted annually in proportion to the percentage change in state Medicaid expenditures. In other words, if the state Medicaid expenditures grow 10%, the county contribution would grow 10%.
- Bases individual county contribution shares, as percentages, on Medicaid enrollment by county. This formula results in significant swings in growth from the current year to FY 13-14 among the counties, ranging from negative 30% to 170%.
- However, as amended, the enrollment-based formula for determining individual county shares would be phased in over seven years, with counties shares ultimately based solely on enrollment percentages in FY 2019-20 and beyond.
- In FY 2013-14, individual county shares would be based on actual payments, as percentages of the total county contribution, in FY 2012-13.
- Beginning in FY 2014-15, individual county shares will be weighted averages of payment-based and enrollment-based percentages. A county’s share will be increasingly weighted towards its enrollment-based percentage until FY 2019-20, when it will be based solely on the county’s percentage share of Medicaid enrollees in the state.
- Allows for counties to pay their contributions in equal monthly installments, by the 5th day of each month; DOR is directed to reduce a county’s half-cent sales tax distribution in the event that the county does not remit payment by the 5th day of the month.
- Maintains language allowing counties to divide payment responsibility proportionately among hospital districts.
- Status: SB 1884 passed in Senate Appropriations, and is on the Special Order Calendar for Monday, April 29. FAC continues to work with Sen. Grimsley and Senate staff on the bill language. The House has not yet released its proposal, although FAC staff remains engaged with House members and staff on the issue.
- Clarifies and updates the statutes relating to unclaimed and indigent burials
- Provides that counties may adopt policies and procedures for the final disposition of unclaimed human remains
- Authorizes counties to make final disposition of unclaimed human remains under certain circumstances
- New language (from last year): allows certain veterans organizations to assist with recovery and interment of unclaimed cremated remains of veterans
- Status: HB 171 passed the full House unanimously and is now in Senate messages. SB 370 has passed all committees and is on the Special Order Calendar for Monday, April 29.
- Currently, sec. 386.209, F.S. preempts the regulation of smoking to the state, except that school districts can further restrict smoking on school district property.
- Bills would remove counties and cities from the preemption, allowing them to further restrict smoking on certain county or municipal outdoor property if they choose do to so by local ordinance.
- SB 258 passed unanimously in Senate Regulated Industries, amended to specify the locations where local governments can restrict smoking as well as the processes for enforcing local smoking ordinances. Additionally, non-smoking areas would have to be clearly defined, and designated smoking areas would be required.
- SB 258 passed 6-3 in Senate Health Policy. The bill allows a city or county to require, as a condition for a lease on property that it owns or controls, that smoking be prohibited on the property; however, it was amended in Senate Health Policy to provide that such a restriction may not apply to a pre-existing lease, including a lease renewal, without the lessee’s consent.
- HB 439 will not be heard in the House this Session.
- The bill failed this year; however, FAC is already working with the various stakeholders in preparation for next Session, as this issue will return.
- Summary: Creates study group to evaluate percentage of funds that counties are required to contribute to Medicaid program & provide recommendations to Governor/Legislature.
- Status: 4 committee referrals in Senate; 3 in House; currently in Health & Human Services Appropriations. The bill failed to move this Session.
SB 1816 – Relating to Health Care
- Summary: Creates “Healthy Florida” within the Florida Healthy Kids Corporation, to provide individuals who fall below 138% of the federal poverty level with access to subsidized private health insurance.
- The plan is an alternative to Medicaid expansion pursuant to the Affordable Care Act (ACA), but relies on the same federal dollars for funding. Federal approval would be required in order for the state to gain access to these funds.
- Enrollees would be offered choices of plans, which would be required to cover certain services and provide health savings accounts. Enrollees would have to meet certain cost-sharing requirements based on their income, which could be as low as $3 or $4 co-pays.
- Plans would be required to meet an 85 percent medical loss ratio.
- Status: SB 1816 passed its two committees unanimously, and has been placed on the Special Order Calendar for Monday, April 29.
SB 1844 – Relating to Health Choice Plus Program
- Summary: Creates the Health Choice Plus (HCP) program to offer a health benefits program for uninsured persons ages 19 to 64 who fall below 100 percent of the federal poverty level but are not otherwise eligible for Medicaid. The program would be managed and administered by the existing Florida Health Choices Corporation.
- Health benefits accounts provided to enrollees would be jointly funded by the recipients and the state (subject to annual appropriations) and would not rely on the federal funds made available to Florida under the ACA.
- Funds deposited into health benefits accounts could be used by the account holder to offset health care costs or purchase health care services from the marketplace.
- The bill has an estimated fiscal impact of $15,275,000 (GR) for SFY 2013-14.
- Status: SB 1844 is on 2nd reading in the Senate.
HB 7169 – Relating to Health Care Coverage
- Summary: Creates the Florida Health Choices Plus Program within the Florida Health Choices Program, to assist certain uninsured persons between ages 19 to 64 who fall below 100 percent of the federal poverty level but are not otherwise eligible for Medicaid, The program would be managed and administered by the existing Florida Health Choices Corporation.
- Similar to SB 7144 (by Sen. Bean/Health Policy Committee), the accounts provided under the plan would be jointly funded by the state and enrollees, and would not rely on the federal funds made available to Florida under the Affordable Care Act.
- The program would provide CARE accounts (contribution amount for responsible expenditures) to enrollees. Each enrollee would receive $2000 in his or her CARE account, subject to annual appropriation, to purchase health coverage products and services available in the marketplace. To maintain eligibility, enrollees would be required to contribute $25 per month into their individual CARE accounts.
- The plan would have a fiscal impact of $11.9M in FY 2014, although the plan would not be launched until late in the fiscal year (April 2014). The fiscal impact is estimated to be $120M in FY 2015, rising to $266M in FY 2023.
- Status: HB 7169 rolled to 3rd reading.